Periodische Atemstörungen bei Schlaganfallpatienten

Zusammenfassung

Verschiedene Arbeitsgruppen haben in den letzten Jahren übereinstimmend eine erhöhte Prävalenz schlafbezogener Atemstörungen bei Patienten mit zerebrovaskulären Krankheiten festgestellt. Die Metaanalyse dieser Studien zeigt, dass die durchschnittliche Prävalenz schlafbezogener Atemstörungen in der Akutphase 71 % und in der Postakutphase 48 % beträgt. Die vorliegende Übersicht fasst die polygraphischen Methoden zusammen, die zur Identifizierung dieser Atemstörungen erforderlich sind. Bezogen auf den einzelnen Patienten kann häufig nicht geklärt werden, ob und in welchem Ausmaß die schlafbezogene Atemstörung Ursache oder Folge der zerebrovaskulären Krankheit ist. Epidemiologische und tierexperimentelle Studien belegen, dass der wichtigste Risikofaktor für zerebrovaskuläre Krankheiten, die arterielle Hypertonie, durch schlafbezogene Atemstörungen ausprägungsabhängig verursacht oder verschlimmert werden kann. Erste Ergebnisse deuten darauf hin, dass auch der Rehabilitationserfolg nach Insult invers von dem Vorkommen und Ausmaß schlafbezogener Atemstörungen in der Akutphase abhängt. Aus diesen Gründen sollte in der Akutphase der Schlaganfallbehandlung neben der Sauerstoffsättigung gezielt und künftig mit geeigneten Methoden die Atmung kontinuierlich überwacht werden, um gegebenenfalls sofort therapeutisch intervenieren zu können.

Abstract

During the last few years several groups found an increased prevalence of sleep-disordered breathing (SDB) in patients with cerebrovascular diseases. Meta-analysis of these studies shows that the average prevalence of SDB accumulates to 71 % in the acute phase, and to 48 % in the post-acute phase of stroke treatment. The present review summarizes the polygraphic methods necessary for the identification of these breathing disorders. In an individual patient it is often impossible to clarify whether and to what extent SDB is the cause or consequence of the cerebrovascular disease. Epidemiological and experimental studies in animals prove that the most important risk for cerebrovascular diseases, i. e. arterial hypertension can be caused or aggravated by SDB in a dose-response relationship. First results point to an inverse relationship between incidence and extent of SDB in the acute phase. Therefore, besides monitoring oxygen saturation in the acute phase of stroke treatment, breathing should be monitored by suitable methods to enable immediate therapeutical intervention.

Key words

Sleep apnea syndromes - Cerebrovascular disorders - Stroke unit monitoring

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